As conjoined twins in a perpetual hug, Kendra and Maliyah Herrin have shared absolutely everything for the past four years -- including an abdomen, pelvis, liver, kidney, large intestine and two legs.
But soon the 4-year-old girls of North Salt Lake, Utah, will undergo a 30-hour surgery so they can live separate lives.

It was difficult for their mother, Erin Herrin, to decide to put her adorable, giggling girls through such an extensive medical procedure.

"I flip-flopped both ways," she said. "I was like, they're healthy, they're safe right now, we can keep them together and keep them safe, or we can separate them and give them the best chance possible of leading separate lives."

"They seem to ... see themselves as being separate when they got older," said Jake Herrin, the twins' father. "They want to be married, they want to be moms."

To emotionally prepare for their separation at Primary Children's Medical Center in Salt Lake City, the twins have been working with a child psychologist, role-playing through their surgery using conjoined dolls that they snip with scissors to separate.

But for Kendra and Maliyah, the real-life operation won't be so simple.

"The dangers of the surgery are tremendous," said Dr. David Staffenberg, chief of pediatric plastic surgery at The Children's Hospital at Montefiore in Bronx, N.Y., who separated conjoined Filipino twins Carl and Clarence Aguirre in a 17-hour operation.

Obstacles, Hope Both Await

When the twins separate, Kendra will get the kidney while Maliyah will have to spend months on dialysis, waiting for a transplant. That's one of the reasons why the twins have waited to do a surgery that is usually done much younger -- to improve Maliyah's chances for a successful transplant.

"To even be considered for separation in the face of a shared organ like a kidney, where one of the girls would have to go out until she could receive a transplant, is really unusual," Staffenberg said.

The hope is that their mother will be a match and will eventually give her daughter a second gift of life.

"I'd donate both my kidneys if that meant that she would be able to live a healthy, normal life for the rest of her life," she said. "I'd do anything for my children. I think most mothers would."

Each twin will get one leg -- they each control one now. Their parents said they hope that with crutches or prosthetics, the girls will be able to walk.

These little twins do see themselves as separate (getting married and having babies of their own someday) but have really had to cooperate with each other up to this point. When one wants to dance that other needs to kick up her heal too... One girl likes computer games and the other likes Barbies.

SALT LAKE CITY · They were born in a perpetual hug, their little bodies fused at the midsection so that they are practically face-to-face, and have grown into outgoing 4-year-olds who chatter away and finish each other's sentences.

Kendra and Maliyah Herrin say they like being together all the time, but they are also full of plans for separate lives. They want to walk without using their wheeled walker, sleep in bunk beds and ride bikes.

On Monday, surgeons at Primary Children's Medical Center will try to separate the twins in an operation that could take 14 to 30 hours.

The sandy-haired, blue-eyed girls share one pair of legs, a liver, one functioning kidney and part of the large intestine. If all goes according to plan, each girl will get one leg and Kendra the kidney. Maliyah will be put on dialysis until she is strong enough for a kidney transplant from her mother, Erin Herrin, ideally within three to six months.

Dr. Rebecka Meyers, the hospital's chief of pediatric surgery, said she believes this will be the first time separation surgery has been attempted on twins with a shared kidney.

Conjoined twins occur about once in every 50,000 to 100,000 births. Only about 20 percent survive to become viable candidates for separation, and most separation surgeries occur when the twins are 6 to 12 months old.

"The reason for that is partly psychological, partly mechanical," Meyers said. "If Maliyah had had a kidney, these girls would have been separated a long time ago."

A kidney transplant would have been harder before age 4, and doctors advised waiting.

Before deciding to go ahead, doctors and the girls' parents -- who also have a 6-year-old daughter and 14-month-old twin boys -- talked with ethicists, because the surgery could make things worse for Maliyah, who faces the risky prospect of an organ transplant.

"We have more than one ethicist who thinks these girls don't need to be separated," Meyers said. "Mom and Dad have had a chance to hear all of that and talk to people on both sides."

Before making their decision earlier this year, the Herrins had Kendra and Maliyah talk with a psychologist. The couple concluded that while the girls expressed some fear about the surgery, separate "was how they saw themselves when they were older," Jake Herrin said.

To prepare them for surgery, doctors inserted 17 expanding balloons into the twins' torsos in June. Filled with saline solution, the balloons stretch the skin and muscles, giving doctors more tissue to work with during plastic surgery after the separation.

To help them understand what is about to happen to them, Kendra and Maliyah have been given a set of conjoined stuffed dolls to play with. Like the girls, the dolls get Band-Aids and shots. On July 20, Kendra performed separation surgery on the dolls, as Maliyah looked on.

"They gave the babies medicine and said that they were so brave," Erin Herrin wrote in a posting on the North Salt Lake family's Web site. "It is incredible to us how much they really do understand."

The twins continue to do well. There have been no set backs as of this afternoon. They've been kept sedated and are not feeling pain. Soon they'll be weaned from their ventilators (breathing machines). I think the plan is for them to return home in 2-4 weeks. They'll need quite a bit of therapy with the long term goal of being fit for prosthetic limbs.

Milayah started on dialysis yesterday. The plan is for her to receive a kidney from her mothers in 2-3 months.

The twins continue to do well. There have been no set backs as of this afternoon. They've been kept sedated and are not feeling pain. Soon they'll be weaned from their ventilators (breathing machines). I think the plan is for them to return home in 2-4 weeks. They'll need quite a bit of therapy with the long term goal of being fit for prosthetic limbs.

Milayah started on dialysis yesterday. The plan is for her to receive a kidney from her mothers in 2-3 months.

That seems to be all for now folks...

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Great News! Things seem to be following plan. Thanks for keeping us updated!